Provider Demographics
NPI:1659819084
Name:TOTAL ACCESS VASCULAR ACCESS SERVICES
Entity Type:Organization
Organization Name:TOTAL ACCESS VASCULAR ACCESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR ACCESS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:STURTEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT-ACCS
Authorized Official - Phone:719-250-3187
Mailing Address - Street 1:65 W LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1778
Mailing Address - Country:US
Mailing Address - Phone:719-250-3187
Mailing Address - Fax:
Practice Address - Street 1:4194 ROYAL PINE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1507
Practice Address - Country:US
Practice Address - Phone:719-250-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68496247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty